Abstract:
BACKGROUND:Prescribing rate control medications with or without antiarrhythmic drugs is often the first course treatment for atrial fibrillation (AF). Clinical trial data suggest that antiarrhythmic drugs are only marginally effective and have multiple drawbacks, whereas rate control alone is sufficient for most patients with minimally symptomatic AF. This study investigates changes in the use of oral rate and rhythm control therapy for AF during fiscal years 2002 through 2011 in the US Veterans Affairs (VA) health system. METHODS:Patients with new AF episodes were identified in Veterans Health Administration administrative data files, and receipt of oral rate- and rhythm-controlling drugs within 90 days of new AF episodes was determined for each patient. RESULTS:The percentage of patients receiving an oral rate-controlling medication decreased from 74.9% in 2002 through 2003 to 70.9% in 2010 through 2011. The use of digoxin decreased by >50%, whereas the use of β-blockers metoprolol and carvedilol increased. The proportion of patients receiving any oral antiarrhythmic medication decreased from 13.5% in 2002 through 2003 to 11.6% in 2010 through 2011, and use of the most frequently prescribed oral antiarrhythmic, amiodarone, decreased by 17%. CONCLUSIONS:Rate control remains the dominant strategy for treating new AF. The decrease in the use of oral antiarrhythmics may be due to lack of concrete data suggesting mortality and morbidity benefit as well as increasing use of the ablation approach. BULLET POINTS:The proportion of patients with new AF episodes who were prescribed oral rate or rhythm control medications decreased modestly from 2002 through 2011. The use of digoxin decreased by >50%, and amiodarone decreased by 17%. Rate control remains the dominant strategy for treating new AF.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Vaughan-Sarrazin MS,Mazur A,Chrischilles E,Cram Pdoi
10.1016/j.ahj.2014.03.024subject
Has Abstractpub_date
2014-07-01 00:00:00pages
53-9.e1issue
1eissn
0002-8703issn
1097-6744pii
S0002-8703(14)00223-3journal_volume
168pub_type
杂志文章abstract::To determine how early myocardial infarction can be detected, serial creatine kinase MB concentrations were sampled in 313 patients during triage of acute (less than 12 hours) chest pain. Serum was sampled on hospital arrival (baseline) and hourly for 3 hours (total of four samples). Creatine kinase MB concentrations ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90646-d
更新日期:1992-02-01 00:00:00
abstract::High levels of endogenous plasma catecholamines in patients with severe congestive heart failure induce a down-regulation of the myocardial beta-adrenoreceptors and thus cause adrenoreceptor agonists, such as dobutamine, to be less effective in the treatment of these patients. Phosphodiesterase III inhibitors work ind...
journal_title:American heart journal
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更新日期:2002-03-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2001-11-01 00:00:00
abstract::Chronic maintenance tocainide therapy was effective in controlling symptomatic, recurrent ventricular tachycardia in 11 of 15 patients. Patients were selected for tocainide therapy on the basis of refractoriness to conventional antiarrhythmic agents and responsiveness to the intravenous administration of lidocaine. Si...
journal_title:American heart journal
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pub_type: 杂志文章,多中心研究
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更新日期:2015-06-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1976-02-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90661-0
更新日期:1994-03-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2007-11-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90415-8
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1992-01-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2014.12.022
更新日期:2015-04-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90551-5
更新日期:1987-12-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90461-5
更新日期:1975-12-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90463-0
更新日期:1984-10-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90277-8
更新日期:1987-02-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90400-8
更新日期:1982-05-01 00:00:00
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pub_type: 杂志文章
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更新日期:1986-11-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1987-09-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2014.02.005
更新日期:2014-05-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2003.09.015
更新日期:2004-03-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:2016-10-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1987-06-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:2019-12-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章
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更新日期:1976-10-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1992-07-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(85)90647-7
更新日期:1985-04-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.03.055
更新日期:2006-02-01 00:00:00